Heidi Murkoff is the author of the internationally bestselling What to Expect series of pregnancy and parenting guides, which includes What to Expect When You’re Expecting, What to Expect: Eating Well When You’re Expecting, What to Expect in the First Year, and What to Expect Before You’re Expecting.
She has sold over 43,000,000 copies in 44 different languages. She is also the creator of WhatToExpect.com and the What to Expect App, a community of twenty million moms. Heidi is also the founder of a nonprofit organization dedicated to helping at-risk moms in the US and around the world called the What to Expect Project.
Time Magazine named her one of the 100 most influential people in the world in 2011. She and her husband Erik have received numerous awards for their humanitarian work, including The Fisher Distinguished Civilian Humanitarian Award in June 2022, the highest award given to civilians by the Department of Defense.
I am so honored to have her on today to talk about what to expect before and when you are expecting. I hope you enjoy this conversation as much as I did!
Dr. Aimee: I am so delighted to have author Heidi Murkoff on today’s show. We’re going to talk about all of the amazing things that she has done. The title of today’s show is What to Expect.
Heidi Murkoff: Thank you. It’s so great to be with you. By the way, you had me at “Egg Whisperer.” I just love that title.
Dr. Aimee: Thank you. Can you tell us about the start of What to Expect When You’re Expecting? I think many people in the audience can probably relate to your inspiration for how this book got its start.
Heidi Murkoff: I got knocked up. It was an “oops” pregnancy. We had just gotten married, and two or three months later, oops, I was pregnant. I was so young and knew absolutely nothing, I was the definition of clueless. The first thing I did was run to the bookstore and bought the two or three books that were on the shelf. I think it was only two. I brought them home and read them and found them uniformly terrifying. I could not relate to what was going on in my body based on this information.
Two hours before I went into labor with Emma, I delivered a proposal for a book that would become What to Expect When You’re Expecting, so it was a busy day, it was a productive day. My first venture into multitasking as a mom. I was a mom on a mission — a mission to provide expecting and new parents the information and reassurance Erik and I craved but couldn’t find. Never expected anyone to buy it. I pretty much thought that if a handful of parents slept better at night than Erik and I had, that I would have accomplished what I set out to do.
Dr. Aimee: What a great story. The What to Expect series has grown so much since then. What has been at the heart of this growth and your passion for the topics around What to Expect?
Heidi Murkoff: The first book What to Expect When You’re Expecting has changed a lot since the first day that it hit shelves. What keeps me going, what motivates me and what inspires me is helping moms and dads through this experience and answering the questions they have that for me went unanswered. By the way, I could have spent 24/7 on the phone with my OB, but in a funny way, I wasn’t empowered even at that point to do that because there was very little of that empowerment in pregnancy for women at that time.
It’s evolved over the years and grown, but the mission is the very same mission that I’ve always had from the first day, and that is to provide that support, that empowering knowledge. Because knowledge is power, but it’s especially empowering when you’re pregnant or you’re a new parent. Because things keep evolving and things keep changing, and because I love moms, babies, dads, families more than I can even begin to tell you, this is my life for the rest of my life. It was unexpected, but I’m so grateful for that.
Dr. Aimee: We can see your passion in what you do with the foundation. I know we’re going to get more into that as well. I’ve heard you say that your books are like a hug. I know so many people feel seen and heard in ways that they might not have before. What has been your approach in each of your books?
Heidi Murkoff: First of all, I think it’s important to remember that motherhood is the ultimate sisterhood. We all share a universal bond, no matter what our socioeconomic, religious, racial, cultural, political profile. There are no red moms, blue moms, moms of different religions. It just breaks down all barriers. We are moms. In the same way, I would say that being a dad is the ultimate brotherhood. It’s that emotional connection that ties us together.
I think that, hopefully, comes across in the books where I’m not just telling you what to do, because my experience is my experience and your experience is your experience, every pregnancy experience is different, every road to conception is different, every parenting experience is different. You can’t be didactic in the way that often books or experts are. Instead, be welcoming to all kinds of experiences and just provide the accurate information and the sense that you’re not alone.
Dr. Aimee: All of that gave me goosebumps. Thank you for sharing that.
I know I’m not saying anything that people don’t know about the rise in stress over the past two-and-a-half years. I see more people experiencing stress in different ways as patients. You’re obviously an expert in so many things. How can couples and partners approach trying to conceive or pregnancy in ways that support their relationship and each other?
Heidi Murkoff: That’s such an important question. You’re right, stress, the stress on couples, the stress on parents, the stress on families has risen exponentially during the pandemic. For a lot of people, it was a nice rest at home and you had a break, and a lot of babies got conceived, but for others it showed some of the issues in your relationship when you’re all of a sudden together 24/7.
In terms of a trying to conceive (TTC) journey, which of course my first one was a journey of the unexpected, but for lots of couples it’s more of a struggle, and for lots of couples it’s a lot of struggle. And if I could give only one piece of advice for TTC couples, and this goes for parenting too, don’t put your relationship on the back burner. Make sure that your relationship is the focus as you TTC — because it’s that love that hopefully will create this life and it’s that love that can best sustain it. The goal is you and your partner first, if you have a partner. Otherwise, be all about yourself, nurture yourself, take care of yourself, that’s equally as important. The rest is less important. Don’t sweat the little stuff as you try to make a little one.
The less emphasis we put on the actual act of making a baby and the more on the love that you have for each other, the better. We all hear stories of couples who conceived as soon as they stopped trying, and that’s for a reason, because they’re not trying, because they’re just enjoying each other. Not that it always works, because sometimes there are physical barriers to conception for him, for her, for both of them sometimes. But whether it’s a quick journey to sperm and egg meeting or a long journey, putting your relationship first is the most important part.
Dr. Aimee: Yes. You mentioned a little bit about relationships changing. How do they change through the phases of growing a family?
Heidi Murkoff: Erik and I have been married 40 years, I don’t know how that’s even possible, and have enjoyed every single day of those 40 years. Even the early sleep deprivation days, because we went straight from honeymoon to baby, no babymoon time at all. I think part of it was that we stayed invested in each other. We had a relationship beyond being a couple of parents, we were a couple. We made time for each other.
Even just connecting through touch is so important. Even a hug, a little grab of your butt, whatever, hand holding, and the kisses you can catch when you can. Not always being about being the parents you are or hope to be, but being about that couple you were, focusing your attention on that. Babies take a lot of attention, absolutely, children do, absolutely, but securing that time for just the two of us — that needs attention too. We’d sit down and have a snack with the kids when they ate dinner and then we’d have our dinner afterward. That’s not realistic for a lot of couples. We worked at home, so it was a lot easier. Still, making that effort, whatever that effort is on both sides is really important. Communication is also key.
Dr. Aimee: So much incredible advice. I feel all of your wisdom should be on mugs, t-shirts, hats. Your first book came around the time, as you shared so lovingly with us how What to Expect was inspired by the birth of Emma. How has being a mother played a role in the books?
Heidi Murkoff: Again, my experience is different from your experience, but just having that perspective, walking in a pregnant woman’s shoes and knowing that her shoes don’t fit because her feet are swollen, I think that really helps. The empathy that comes from having the experience.
It’s not a matter of “I know exactly what you’re going through”, because I can’t always know that, but “I feel what you’re going through”. I’ve met moms in South Sudan and in Bangladesh who I felt instantly connected to. Our experiences are vastly different, the challenges that we faced vastly different, but yet I relate to your experience in some fundamental way. Being a mom is for me really an important part of that, and a mom who didn’t always know what to do, who didn’t always know what to expect, far from it. I think perspective is really part of that, being a mom.
It’s funny because like every mom, every human mom at least, I made mistakes, I learned from some of the mistakes, and I repeated some of them over and over again. So I get that, I embrace that, I relate to that. I know you’re going to have those days — like I did — and you’re going to lose it sometimes — as I did — and that’s okay. I’ve been there at the bewitching hour. I know what it’s like to have a baby with colic. Actually, two. That perspective helps immeasurably.
Dr. Aimee: I love it. Can you tell me more about how your family has been a part of the What to Expect world?
Heidi Murkoff: Besides being the inspiration for What to Expect When You’re Expecting, when I was doing the fifth edition of the book, Emma got pregnant. By the way, through IVF [in vitro fertilization], Lennox is an IVF baby. She was pregnant, and I’m like what a perfect cover for the book, full circle. A lot of people say, “Is that you on the cover?” I’m like no, I don’t even have photographs of myself pregnant. We didn’t even have a camera. There are like two old Polaroids, that’s it.
That’s Emma on the cover and that’s Lennox on the cover of First Year when he was a baby, because he was in the right uterus at the right time.
Dr. Aimee: I’d love to get your perspective on what has changed since you first wrote What to Expect. Let’s start with the world of trying to conceive and pregnancy.
Heidi Murkoff: First of all, getting pregnant has changed. That wasn’t something we really thought a lot about. Clearly, I didn’t give it a second thought, I just got knocked up. Back in my mother’s generation, and my grandmother’s generation, it was a matter of it was something you did, every woman did it. When a woman couldn’t get pregnant, really very little attention was paid to it, just whispers around. There were very few options in terms of getting pregnant beyond the time-honored one. It was something that every woman had to do. If she didn’t, then there was something a little off about her. Now we read a book like What to Expect Before You’re Expecting to prepare for even getting pregnant.
Let’s face it, a lot of things about pregnancy have never changed, and will never change. It’s still about nine months, give or take. The tenth month is always the hardest if you have to go there. I did. You’re bloated, you’re queasy, you’re constipated, you have mood swings.
But so many things have changed. Certainly dozens of recommendations and guidelines, a lot of the best medical practices, birthing options. I updated my books to cover COVID and more about Black maternal health and about perinatal mood and anxiety disorders (PMADs). So, lots of things have changed.
At the same time, I think what I would say has changed the most, and you can look at the cover of What to Expect and see that Emma is joyful on the cover, she’s happy to be pregnant, she’s proud to be pregnant, she’s showing off her belly and she’s smiling, which is a far cry from what we used to do. You had to wear, like, a polyester tent that you could sweep a family of four under, you did not show that you were pregnant because that was considered, like, dirty. Right?
It’s that sense of pride, of purpose, of being empowered as a woman about your body, something that we didn’t know much about what was happening to your body. The cover is sort of a metaphor for how things have changed.
Another way that they’ve changed a lot is that I had no pregnant friends. We weren’t planning to get pregnant, we were the first kids on the block to get pregnant, so I didn’t have anybody who could relate except for Erik, and he had never been pregnant before. We were just thrust into this without that support system.
Now you’re pregnant, you sign up on the What to Expect App. If you have enough time on your hands, you can make thousands or even millions of friends who are going through the same experience at the same time. I feel that makes it so much less lonely. It still can be very lonely. During COVID, it was certainly extremely lonely.
Another difference is that we pay more attention to mental health. Until recently, we never talked about it, but it’s so critical for moms to know what the signs are of a maternal mood disorder and to be able to seek treatment and feel like there is no stigma in that.
So, a lot of changes for the better. I would say there’s a mixed blessing about Doctor Google, because you can go down a lot of rabbit holes that are hard to dig out of. I had no information. Now you can have extreme TMI, to an extent that your head is spinning, and there’s a lot of conflicting information, and misinformation, and disinformation, so you really have to be careful what you read online, especially when it comes from less reliable sources, like influencers or others who have agendas besides vetting the content you’re reading.
There’s more stress on parents than ever before, especially on moms. In terms of things that have changed, lots of things. I put my babies to sleep on their tummies, we put them to sleep on their backs now. We started our babies on solids at four months, now we know that’s not appropriate, and don’t do the rice cereal, and now it’s at six months and it’s baby-led weaning.
A lot of those things have changed, but the pressure to be a perfect parent, which by definition for human parents does not exist, is so great. To be a perfect woman, to be a perfect wife or partner, to be a perfect mom. No such thing. Don’t even try. I think Instagram and other social media just puts that pressure on, and we need to relieve that. Using social media more as a support system than as something to measure up against.
Dr. Aimee: What have you seen change as far as how society sees family growth since you wrote What to Expect?
Heidi Murkoff: In terms of family growth, I would say I meet a lot of moms from different backgrounds, and I think it depends a lot on what kind of background you have, what kind of career path you have. For many women, it’s something they put on hold until they’re ready. A lot of people put their baby plans on hold.
I met a mom recently who was on her 13th baby. Some parents are perfectly happy and could be completely content with one. It’s such a personal choice, when you have a choice. You don’t always have a choice, based on your timeline. It’s not my place — r anyone’s place — to judge your choices.
Dr. Aimee: I’m really glad that you said that. I feel like when you have a baby, the first thing people ask you is when you’re going to have your second. One child can certainly be enough for a family.
Heidi Murkoff: Absolutely. It’s not quantity, it’s quality, first of all. It’s what works for your family. Everything is about what works for your family, because your family is different from the family down the block. Everything about parenting is finding what works for you, and not listening to others who say that’s the wrong way, you have to do it this way. Same thing about pregnancy.
Dr. Aimee: I feel like you should have a column “Ask Heidi,” where people could ask you what you would do, or what you would say, because you’re amazing.
Heidi Murkoff: By the way, I answer questions on Instagram.
Dr. Aimee: I love that. Share with us some of your pearls here. What’s one thing or a couple of things that you wish anyone trying to conceive should know?
Heidi Murkoff: The importance of preconception care has been recognized only recently, and still isn’t given the attention it deserves. The healthier you are at the time you conceive, the greater your chances of having a healthy pregnancy and a healthy baby — and having a healthy future. And there’s a lot in the planning. Sure you can skip to the good part — getting pregnant — but it’s much better, if you have the luxury of planning and prepping, to get healthy before you get busy. And covered, too, by health insurance if you’re not currently covered or your plan doesn’t include the benefits you’ll need, or the prenatal provider you’ll want. Start taking a prenatal supplement — there’s no down side, and a lot of potential upside, in taking one even if your baby plans are a year or more away. Get your weight where it needs to be for better fertility and better pregnancy health, and your partner’s weight, too. Both of you should get any chronic conditions under control.
And while we’re talking fathers, which we always should be, it’s also important that we recognize the role they play in making a healthy baby. We all know that they contribute a sperm, but the health of that sperm, and in some ways the health of that pregnancy, is dependent on a father’s health. Fertility can certainly be impacted, for better or for worse. Getting both of you into tip-top baby-making shape is one of the best things that you can do, and it’s more fun when you’re doing it as a couple. Whether it’s eating better together, exercising together, losing weight together, improving your lifestyle together.
Scheduling your preconception consult, getting a full check — and that goes for both of you. Changing up any medications that aren’t fertility or pregnancy friendly. Getting a dental checkup and taking care of any dental problems and any periodontal disease, which can get worse during pregnancy and even lead to pregnancy complications if untreated before conception.
Also, a mental health checkup. If you are under treatment for a mood disorder, or if you’ve ever been under treatment for a mood disorder,, check in about that. If you’re currently taking medications for a mood disorder, check with your provider about whether you’ll need to change meds or your dose before you TTC.
A lot of moms decide, “I’ll just chuck the antidepressants because they must be bad for the baby,” and that’s a big mistake to make. You should never wean yourself off of medication without medical supervision, and you might be setting yourself up for a perinatal mood disorder. There are meds that are safe to take, others that are less safe — but often the benefits of taking a med for a mood disorder is much greater than any risk.
Those are some of the fundamental steps to take. Then you can lie back (or on top) enjoy the journey, have fun getting pregnant if you can, and focus on your relationship.
Dr. Aimee: Such great advice. I tell my patients, “nurture yourself and imagine that you’re pregnant right now.” I think sometimes we treat our bodies like trash and then once we’re pregnant we start taking good care of ourselves, sleeping well, hydrating, eating healthy. We should really be focusing on that before we even get pregnant, so I’m glad you said that.
Heidi Murkoff: Cutting back on caffeine. You don’t have to cut it out entirely. Cutting out drinking. Quitting smoking, weaning yourself and your partner off weed. You never know when that egg and sperm will meet and make a baby, so taking your prenatal vitamin way in advance before you start trying, not once you become pregnant.
Dr. Aimee: Right. What is something that you wish someone who is pregnant right now, what should they know?
Heidi Murkoff: First of all, that you’re not alone. You’re not the only one with those crazy symptoms that don’t seem at all related to pregnancy.
What does a nosebleed or sinus infection have to do with making a baby? It seems completely unrelated.
Red palms or just your feet growing, what does this have to do with making a baby?
But there are lots of different things that hormones do that don’t necessarily sound like they make a lot of sense, but there is actually a purpose behind all of those weird symptoms. And sometimes there’s pain with the purpose..
Know that you’re not alone. Know that every pregnancy is different. Every labor and delivery is different. As much as you can, keep your mind open. Ask your doctor or midwife any questions that you have. There’s no such thing as a silly question. If it’s important to you, it should be important to your provider.
Just speak up. I think especially for Black moms, we know that often they aren’t heard, they aren’t listened to, especially when it comes to pain that they experience or symptoms that they’re experiencing. That’s why we have a higher incidence of maternal mortality in certain communities because really nobody is paying attention. It has nothing to do with socioeconomic level, it just has to do with inherent bias. Make sure that you speak up.
Something else that I would recommend for everyone is a doula. I would say doulas are a must-do, because they will be there to advocate for you, to be by your side. They don’t take the place of your partner, they are just this incredible source of support, both mental and physical. Doctors come and go, even midwives come and go, nurses come and go on different shifts, hopefully not too many shifts, but the doula is there by your side from the first contraction.
Studies have shown that women who have a doula-assisted birth are less likely to need interventions, and are less likely to suffer from postpartum depression, because often their births are less traumatic. So put finding a doula on your to-do list!
Dr. Aimee: I love that. I would say that maybe three years ago I wasn’t telling patients in my field of work to get a fertility coach, but I actually recommend that now, not my patients because they have me, but for patients who don’t have me guiding them along the way. Just like you said, doctors come and go, patients are going to these huge centers with six to ten doctors, and they see a doctor just for 10 minutes on one video call. That coach will not come and go, that coach will be there for you and be there to hand-hold you. I would say that, maybe, time to pregnancy is shorter if you have someone like that in your life.
Heidi Murkoff: That’s a really important point. I need to add that to What to Expect Before You’re Expecting, so give me all the details.
Dr. Aimee: I will. What is your advice for families right now?
Heidi Murkoff: Families right now have a lot going on. They have a lot of challenges. Even if COVID were behind us, which let’s face it, it isn’t yet, there’s always something else around the corner that is adding to stress. Parents have a way, but especially moms have a way of demanding perfection in themselves, and in so many ways making everything top priority. You can’t do that. It’s not humanly possible. Again, we are human parents.
Letting the little things go, not the little things in your arms, but the little things that don’t matter as much, prioritizing what’s important to you and your family. I think also staying connected as partners, seeing each other as partners.
I’m a big “dadvocate,” so I am always talking about dads and how important they are to the process. Not just as someone who is contributing that important sperm, but as someone who stays connected through pregnancy and through the entire journey, not as a babysitter, as a co-parent. I know that can have a different connotation, but you are in this together as a team. There’s nothing that a mom can do that a dad can’t do just as well, if not better, given the opportunity, except for breastfeed. Beyond that, we’re working on it.
I think presenting as a team makes you stronger. Being united makes you stronger, and it makes your family stronger and feel more secure.
Dr. Aimee: “Dadvocate!” I love that.
How can people find you and your books and your organization? I would also love for you to share more with us about the What to Expect Foundation.
Heidi Murkoff: You can find me on social media. I’m so easy to find, it’s not even funny. It’s @HeidiMurkoff. If you message me and you ask me a question, I will not only accept it, but I will answer it. Every mom and dad means so much to me. Then the app is the What to Expect App, and you get weekly video updates from me and lots of personalized information.
The What to Expect Project is so important for me, it’s really the heart of what we do. I love everything except writing, by the way. Everything else, the interactions, doing this, just loving on moms, that’s what it’s all about for me, and advocating for them. The What to Expect Project actually started after I did a visit with pregnant inmates at Rikers Island. What I noticed right away is that every mom wants the best for her baby. With that in mind, we started this foundation that would inform and empower every mom as much as possible.
I’ve been all over the world hugging up a storm. Refugee camps, displaced person camps, just about everywhere. We have lots of programs. The one that I actually just got back from was a baby shower at Fort Riley. We have done maybe 300 baby showers for military moms around the world, so that’s probably 30,000 moms or so. During COVID it was really hard because we had to do them virtually.
It’s all about the hugs, the support, and the celebration. If you can imagine the isolation of being thousands of miles away from your family, your friends, and your usual network of support, that’s daily life for a military mom. During COVID, that has been exponentially harder. It has been exponentially harder for every one of us, but say you’re stationed in Japan, or you were when this all started, you didn’t see your family for two years. Grandparents couldn’t come and visit, so you’re going through this all on your own.
That’s one of the favorite things that I do, but we’re also going back to DC next week, and we go all the time, to advocate for maternal health for military moms, but also for moms who don’t get the continuum of care that they need and deserve, including preconception care or postpartum care, which is currently not a given in a state that hasn’t expanded Medicaid or has limited reproductive rights.
There are lots of moms out there who need lots of support, and as long as there are, we’re going to be out there supporting them with the What to Expect Project.
We have Bump Day every year, that’s the third Wednesday in July every year. We just recently had our ninth annual.
Dr. Aimee: That’s awesome. Along the lines of advocating for preconception care, I have this dream that you go to this website and say, “I’m trying to conceive.” We as a society have to start now, because we’re generations off from — we’ve basically screwed up at least two generations in terms of plastic exposure, poor health, and like you said, no preconception care.
Things are going to get so bad. If we don’t do it now, it’s just going to get worse. I want meals delivered, vitamins delivered, and people hooked up to exactly what you’re talking about. Have a consult with a doctor and a mental health specialist even before trying to conceive. The time really needs to be now.
Heidi Murkoff: On that note, I think it’s really important, we have skyrocketing rates of diabetes in this country, and heart disease, and other chronic conditions that are in many cases completely avoidable and preventable. We think it’s something that happens later on, but in fact your baby’s chances of later on developing Type II diabetes are at least partially determined by your health before conception, and at the moment of conception, and during pregnancy. I call it the ultimate in preventive care.
In terms of health care costs, if we actually helped women get healthy, couples healthy, before they get pregnant, we would lower health care costs, special care during pregnancy, complications during pregnancy, NICU care, lifelong care, rates of diabetes, cancer, hypertension, you name it. It’s such a smart investment. Anything that invests in the health of women, invests in the future of our country. If moms aren’t healthy, none of us are going to be healthy.
Dr. Aimee: Yes. The other thing that I want to also promote, and when you go to DC, please talk to them about this, is first trimester leave. I feel like as a society we still cause women to feel shame when they’re pregnant and they can’t talk about it at work, and they hide their pregnancy and they’re not taking care of themselves. If they’re throwing up or they’re not sleeping well, they still make themselves go to work. I feel like we have to support women in the first trimester.
Heidi Murkoff: There’s not enough support for women who are doing the heaviest lift of all, they’re nurturing our future. All of this is weighing on them, and instead of supporting them, we just say pull yourself by your bootstraps and get back to work. That’s not okay. We need to support them through the process.
Also, we need preconception care and fertility care to be affordable for every couple who needs it. I find it unacceptable that it’s for wealthy people only, or you have to throw away your savings, or if you’re a military family who makes very little, maybe you can’t afford it at all. We should be offering a continuum of care for every woman who wants to become pregnant, every couple, every family.
Dr. Aimee: Absolutely. It’s about love, showing people love. If we show them love, that they’re important to this world, I could go on and on about the other downstream things we’ll see that will decline, like mental health illness.
Heidi Murkoff: Exactly.
Dr. Aimee: For me, it’s school shootings. People are like, “What?” Literally, I feel like if we show people love before they’re even an embryo, potentially we can change what we’re seeing right now. Like I said, we’re generations away from that, so we really need to act now.
Heidi Murkoff: We have to catch up with other countries who do a far better job of nurturing women in general. We’re not giving them the support that they need and deserve. By the way, it’s good for the economy.
Dr. Aimee: For sure.
Heidi Murkoff: Cost saving, but also makes women stay in the workforce if they are supported. We all know women are better at everything, so it’s a win-win.
Dr. Aimee: Heidi, I’ve so enjoyed our talk today. I just feel so fortunate and lucky. I’m one of those people that reached out to you on Instagram, and you replied to me within seconds. I just feel so honored. Thank you so much for taking this invitation to talk to us today.
Heidi Murkoff: I’m so happy that we had a chance to chat, and more where that came from.
Dr. Aimee: Exactly. I look forward to the next time. Thank you so much.
Heidi Murkoff: Thank you for what you do.